Child Sleep Apnea – Overview & Facts

Obstructive sleep apnea (OSA) is a sleep related breathing disorder. It is one component of a spectrum of sleep disordered breathing.

OSA occurs when the muscles relax after you fall asleep. As a result soft tissue in the back of the throat collapses and blocks the airway. This leads to partial reductions in breathing. These are called “hypopneas.” It also can lead to complete pauses in breathing. These are called “apneas.” In children these obstructions tend to occur during the stage of rapid eye movement (REM) sleep.

Even brief apneas can cause a child to have low levels of oxygen in the blood. This is called “hypoxemia.” It can occur quickly in a child with OSA. Because children have smaller lungs, they have less oxygen in reserve. Children tend to take frequent, shallow breaths rather than slow, deep breaths. This also can cause a child with OSA to have too much carbon dioxide in the blood. This is called “hypercapnia.”

Adults with OSA often have fragmented sleep. They tend to wake up briefly after their breathing stops. Children with OSA often do not wake up in response to pauses in breathing. They have a higher “arousal threshold” than adults. As a result their sleep pattern tends to be fairly normal.

Excessive daytime sleepiness is more common in adults with OSA than in children with OSA. Older children and teens are more likely than younger children to have this problem.

Most children with OSA have a history of snoring. It tends to be loud and may include obvious pauses in breathing and gasps for breath. Sometimes the snoring involves a continuous, partial obstruction without any obvious pauses or arousals. The child’s body may move in response to the pauses in breathing.

Younger children have a very flexible rib cage. As a result the breathing problems can produce unusual movements of a child’s chest and abdomen. The rib cage may appear to move inward as the child inhales. This is called “paradoxical movement.” Parents often notice that the child seems to be working hard to breathe. For healthy children over three years of age, this type of breathing is not normal.

In extreme cases a child with untreated OSA may develop a “funnel chest” over time. The ongoing breathing problems cause the sternum, or “breastbone,” to sink in. This produces a depression in the chest wall.

Children with OSA may sleep in unusual positions. They may sleep sitting up or with the neck overextended. They also may sweat a lot during sleep and may have headaches in the morning. Bedwetting or sleep terrors also may occur.

Children with OSA tend to breathe normally when they are awake. But it is common for them to breathe through the mouth. They may have frequent infections of the upper respiratory tract. Some children with OSA have such large tonsils that they have a hard time swallowing. This is called “dysphagia.”

Symptoms of OSA tend to appear in the first few years of life. But OSA often remains undiagnosed until many years later. In early childhood OSA can slow a child’s growth rate. Following treatment for OSA children tend to show gains in both height and weight. Untreated OSA also can lead to high blood pressure.
Cognitive and behavioral problems are common in children with OSA. These problems may include: